1. Department of Health, Welfare and Sport Transition of the Dutch health care system focused on hospital care May 26th 2005 Marc Soeters Maaike Prins Diagnosis Treatment Combinations

2. Department of Health, Welfare and Sport Agenda Presentation on the transition of the Dutch health care system with focus on the hospital market (20 minutes) Questions

3. Department of Health, Welfare and Sport presentation Problems with old system Outline new health care system Focus on hospital care and introduction of DBCs

4. Department of Health, Welfare and Sport Old system of health care Government regulated system: –prices/tariffs –Budgets –Capacity (hospitals) –Insurers obligated to contract all suppliers of health care

5. Department of Health, Welfare and Sport Problems large increases of budget in past years But still shortage (waiting lists) and complaints about quality

6. Department of Health, Welfare and Sport New health care system in Cure Central role Insurers in contracting (and organizing) health care With efficient contracting and organizing health care insurers can lower costs (and lower insurance premiums) Competition on insurance market forces them to keep premiums low with efficient contracting

7. Department of Health, Welfare and Sport Conditions insurer market –Competition on the market for health care insurers –Level playing field on insurer market (new law on general health insurance) –Risk-equalisation (ex ante, not on actual expenses) –Selective contracting of health care supply

8. Department of Health, Welfare and Sport Requirements on supply of hospital care Enough competition on supply side of hospital care Transparent products (DBCs) No negotiations on prices on acute hospital care (and some other minor parts of the hospital market)

9. Department of Health, Welfare and Sport Introduction of DBCs in 2005 Definition of hospital products in terms of DBCs (diagnosis treatment combination) Contracting on prices and quantity for 10% of the DBCs 90% government sets prices within budget system

10. Department of Health, Welfare and Sport DBC development in the Netherlands Started slowly in mid 90’s Initiated by providers and insurers Adopted by government in 2000 Implemented by January 2005 Market oriented approach for 10% of hospital products

11. Department of Health, Welfare and Sport What is a DBC? DBC: Diagnosis Treatment Combination Uniform defined health process description Description of the total health path Cost homogeneous and medical coherent

12. Department of Health, Welfare and Sport Summary of unique aspects DBCs Episode management / medical process description DBCs are applicable for all hospital activities (including outpatient and daycare) DBCs include the remuneration of medical specialists Registration during the health care process

13. Department of Health, Welfare and Sport Scope DRG GP Outpatient visit(s) Clinical episodes Homecare GP Rehab / Aftercare Daycare

14. Department of Health, Welfare and Sport GP Outpatient visit(s) Clinical episodes Homecare GP Rehab / Aftercare Daycare Scope DBC

15. Department of Health, Welfare and Sport DBC versus DRG